High-quality Videoconferencing Research Articles

Estimating PQoS of Video Conferencing on Wi-Fi Networks Using Machine Learning

Video conferencing services based on web real-time communication (WebRTC) protocol are growing in popularity among Internet users as multi-platform solutions enabling interactive communication from anywhere, especially during this pandemic era. Meanwhile, Internet service providers (ISPs) have deployed fiber links and customer premises equipment that operate according to recent 802.11ac/ax standards and promise users the ability to establish uninterrupted video conferencing calls with ultra-high-definition video and audio quality. However, the best-effort nature of 802.11 networks and the high variability of wireless medium conditions hinder users experiencing uninterrupted high-quality video conferencing. This paper presents a novel approach to estimate the perceived quality of service (PQoS) of video conferencing using only 802.11-specific network performance parameters collected from Wi-Fi access points (APs) on customer premises. This study produced datasets comprising 802.11-specific network performance parameters collected from off-the-shelf Wi-Fi APs operating at 802.11g/n/ac/ax standards on both 2.4 and 5 GHz frequency bands to train machine learning algorithms. In this way, we achieved classification accuracies of 92–98% in estimating the level of PQoS of video conferencing services on various Wi-Fi networks. To efficiently troubleshoot wireless issues, we further analyzed the machine learning model to correlate features in the model with the root cause of quality degradation. Thus, ISPs can utilize the approach presented in this study to provide predictable and measurable wireless quality by implementing a non-intrusive quality monitoring approach in the form of edge computing that preserves customers’ privacy while reducing the operational costs of monitoring and data analytics.

How to Prevent Technical Issues in Large Multiparty Medical Videoconferencing

Introduction: Videoconferencing (VC) is useful for physicians who need to learn about many cases without moving from one institution to another. However, this advantage can be hampered by technical issues. This study aims to analyse the factors relating technical support that cause technical issues in regular multiparty medical VC to provide high-quality VC to meet participants’ demands. Methods: The study includes large multiparty VC between the Kyushu University Hospital Department of Paediatric Surgery and different institutions within Japan that were held from September 2014 to January 2017. Technical tests, a “previous-week test” and a “last-hour test,” were conducted for checking conditions prior to the VC. The chi-square test was used for factors: participation for previous-week and last-hour test, and attendance by an engineer VCs in each participating institution. A questionnaire survey was distributed among the participants to collect feedback on the quality of VC, ease of preparation and necessity of previous-week testing. Results: Participation in the last-hour test (P=0.002) and the presence of an engineer (P=0.049) significantly decreased overall technical issues. The last-hour tests significantly decreased disconnection (P=0.015) and audio (P=0.019) issues. The engineer’s attendance decreased content-sharing issues (P=0.027). Participants reporting “very good” and “good” audio and visual quality were 92% (109/118) and 96% (105/110). Eighty-three percent of participants (82/99) found the preparation “very easy” or “easy”; while 61% (63/103) found the previous-week test, “unnecessary.” Conclusions: Based on our study, “engineers’ attendance” and “last-hour” technical testing significantly reduced technical problems; these factors help provide high-quality output VC and meet the needs of the participants.

Bridging care gaps: using tele-health to provide care for people with autism spectrum disorder

Objectives: Explore the usage of tele-health to conduct diagnostic assessments and interventions for people with Autism Spectrum Disorder (ASD).Methods: A Pubmed search was conducted using the words tele-health, telemedicine, video conferencing and telepyschiatry in conjunction with the words ASD, Autism, Asperger’s, and Developmental Disabilities. Personal experience from the first author, a tele-health and ASD expert, was also utilized.Results: While tele-health usage and satisfaction are high, its utility in the diagnosis of ASD is limited. There are few studies to support the validity of the ADOS and Autism Diagnostic Interview(ADI), gold standard diagnostic tools, when administered via videoconferencing.Conclusion: Tele-health with high-quality videoconferencing to provide health care, is an excellent venue to see patients with ASD that live far from experts. Its suitability as the venue for diagnostic assessment is acutely limited. It is a useful tool to triage and engage patients and families, an effective venue to provide education and training for caregivers, healthcare providers and other professionals and an effective modality to provide symptom management.

Comparison of Bedside and Remote Assessments on the NIHSS Scale in Patients in the Acute Period of Stroke

Objectives – remote assessments on the NIHSS conducted by neurologists using high-quality video conferencing (VC) is recommended when bedside assessment by such a specialist is not available. This recommendation is based on a small number of studies which are not free of systematic errors associated with the subjectivity of the NIHSS. The aim of this study was to minimize these errors. Materials and methods. Six experienced neurologists took part in the study and worked in 15 pairs, along with 90 patients with stable poststroke status no more than 48 h after symptom onset. Each pair of doctors assessed six patients. Each patient was independently evaluated once at the bedside and once remotely. During remote assessment using high-quality VC, the neurologist was assisted by a nurse at the patient’s bedside. The distribution of patients by pairs of doctors and sequences of bedside and remote assessments were randomized by block randomization. The comparability of the assessments was evaluated using the κ coefficient and in terms of the proportion of patients for which difference between total NIHSS scores were no more than three points. Results. Differences in NIHSS assessments of no more than three points were obtained in 85.6% (95% CI 76.6–92.1%) of patients. Thus, in practice, remote assessments were clinically significantly different from bedside assessments in one in five patients. Quadratically weighted κ values for total scale scores were 0.91 (95% CI 0.87–0.95). The least concordant subscales were: following commands (ϰ = 0.46), facial muscle paresis (ϰ = 0.43), and limb ataxia (ϰ = 0.27). Remote assessments took longer than bedside assessments: 8 [7, 9] min compared with 6 [5, 8] min (p < 0.001). Conclusions. Remote NIHSS assessments of stroke patients using high-quality VC were comparable with bedside assessments, though further evaluation is required to determine suitability for clinical practice.

A Comparison of Remote and Bedside Assessment of the National Institute of Health Stroke Scale in Acute Stroke Patients

Introduction: Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when the facility of a direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to the subjective nature of NIHSS administration. We aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. Patients and Methods: Ninety stroke patients within 48 h of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing (HQ-VTC), assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures. Results: Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6-92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted kappa for total NIHSS score was 0.91 (95% CI 0.87-0.95). Minimal agreements were for commands (k = 0.46), facial palsy (k = 0.43), and ataxia (k = 0.27). Remote assessments were longer than bedside: 8 min (interquartile range, IQR 7-9) vs. 6 (IQR 5-8), p < 0.001. Conclusions: NIHSS-telestroke assessment using HQ-VTC in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.

A comparison of remote and bedside assessment of the NIH Stroke Scale in acute stroke patients

Telestroke videoconference for conducting the National Institute of Health Stroke Scale (NIHSS) is recommended when direct bedside evaluation by a stroke specialist is not immediately available for hyperacute stroke assessment. However, some NIHSS-telestroke studies inherit systematic bias due to subjectivity of NIHSS administration. Authors aimed to evaluate NIHSS telestroke assessment, while implementing measures to minimize subjectivity bias. Ninety acute stroke patients within 48 hours of onset were assessed by 6 stroke neurologists grouped in 15 pairs. Each pair of physicians assessed 6 patients. Patients were allocated through block randomization to a physician pair and order of bedside or remote assessment. Every patient was assessed once at the bedside and once remotely. Remote examination was performed by a neurologist through high-quality videoconferencing, assisted by a nurse at the patient's bedside. Kappa coefficients and the number of patients with a cumulative difference of ≤3 NIHSS points were calculated to compare bedside and remote measures. Cumulative difference of ≤3 NIHSS points was observed in 85.6% (95% CI 76.6%; 92.1%) cases. Therefore, every fifth remote examination may have been inaccurate. Quadratically weighted κ for total NIHSS score was 0.91 (95% CI 0.87; 0.95). Minimal agreements were for commands (κ=0.46), facial palsy (κ=0.43), and ataxia (κ=0.27). Remote assessments were longer than bedside: 8 minutes (IQR 7; 9) versus 6 (IQR 5; 8), p<0.001. NIHSS-telestroke assessment using high-quality videoconferencing in the acute stroke settings is closely matched with NIHSS-bedside assessment but it's credibility for clinical use needs further evaluation.

Obstacles and Solutions in the Implementation of Telestroke

The American Heart Association in its 2013 Stroke Statistics Update1 reports the annual direct and indirect costs of stroke in the United States to be $62.7 billion, with 15% to 30% of stroke survivors being permanently disabled and 20% requiring institutional care at 3 months after stroke. Rapid recognition and accurate diagnosis are critical to optimize outcomes in patients with acute stroke. Patients treated within 90 minutes of stroke onset with the thrombolytic tissue-type plasminogen activator (tPA) have increased odds of improvement at 24 hours and favorable 3-month outcomes compared with patients treated later than 90 minutes.2,3 Timely thrombolytic treatment also substantially lowered the long-term costs of stroke.4 In the United States, there are ≈4 neurologists per 100 000 people, caring for >700 000 acute strokes per year,5 although many parts of the United States lack access to acute stroke services entirely.6 Telemedicine provides a means to increase access to limited specialty expertise and facilitate timely remote neurological assessment, neuroimaging evaluation, and therapeutic decision making for patients with acute stroke. In its 2009 Scientific Statement, which reviewed evidence for the use of telemedicine within Stroke Systems of Care, the American Heart Association/American Stroke Association “recommended that a stroke specialist using high-quality videoconferencing provide a medical opinion in favor of or against the use of tPA in patients with suspected acute ischemic stroke when on-site stroke expertise is not immediately available.”7 In making this class 1 recommendation, the American Heart Association/American Stroke Association cited studies that showed increased rate of tPA treatment and good functional outcomes at telestroke network hospitals. The TEMPiS project established high-quality videoconferencing services to a network of 12 regional hospitals in Bavaria serviced by 2 stroke centers.8 It reported a 10-fold relative increase in tPA treatments at telestroke …

Deploying a Rural Wireless Telemedicine System: Experiences in Sustainability

A primary concern for projects supported by aid programs is sustainability. Although there is a growing belief that information and communication technologies (ICT) can significantly impact development, in practice creating sustainable ICT projects is extremely difficult. A typical project consists of a pilot stage that aims to demonstrate the basic goals, followed by a deployment stage that aims for both scale and sustainability. A novel ICT project in rural India uses long-distance Wi-Fi networking to enable high-quality videoconferencing between eye hospitals and remote village clinics. The project highlights the importance of sustainability as a first-class goal for systems research.

Primary care patients in psychiatric clinical trials: a pilot study using videoconferencing.

BackgroundWhile primary care physicians play a pivotal role in the treatment of depression, collaboration between primary care and psychiatry in clinical research has been limited. Primary care settings provide unique opportunities to improve the methodology of psychiatric clinical trials, by providing more generalizable and less treatment-resistant patients. We examined the feasibility of identifying, recruiting, screening and assessing primary care patients for psychiatric clinical trials using high-quality videoconferencing in a mock clinical trial.Methods1329 patients at two primary care clinics completed a self-report questionnaire. Those screening positive for major depression, panic, or generalized anxiety were given a diagnostic interview via videoconference. Those eligible were provided treatment as usual by their primary care physician, and had 6 weekly assessments by the off-site clinician via videoconferencing.Results45 patients were enrolled over 22 weeks, with 36 (80%) completing the six-week study with no more than two missed appointments. All diagnostic groups improved significantly; 94% reported they would participate again, 87% would recommend participation to others, 96% felt comfortable communicating via videoconference, and 94% were able to satisfactorily communicate their feelings via video.ConclusionResults showed that primary care patients will enroll, participate in and complete psychiatric research protocols using remote interviews conducted via videoconference.

EMR based telegeriatric system

Introduction: As medical services improve due to new technologies and breakthroughs, it has lead to an increasingly aging population. There has been much discussion and debate on how to solve various aspects such as psychological, socioeconomic and medical problems related to aging. Our effort is to implement a feasible telegeriatric medical service with the use of the state of the art technology to deliver medical services efficiently to remote sites where elderly homes are based. Telegeriatric system will lead to rapid decision-making in the presence of acute or subacute emergencies. This triage will also lead to a reduction of unnecessary admission. It will enable the doctors who visit these elderly homes on a once-a-week basis to improve their geriatric management skills by communication with geriatric specialist. Nursing skills in geriatric care will also benefit from this system. Integrated EMR service will be indispensable in the face of emergency admissions to hospitals. Evolution of EMR database would lead to future research in telegeriatrics and will help to identify the areas where telegeriatrics can be optimally used. Methodology: This system is based on current web browsing technology and broadband communication. EMR web based server is developed using Java Technology. EMR database was developed using Microsoft SQL server. Both are based at the Medical Informatics Programme, National University of Singapore. Two elderly homes situated in the periphery of Singapore and a leading government hospital in geriatric care has been chosen for the project. These three institutions and National University of Singapore are connected via ADSL protocol, which support high bandwidth, which is necessary for high quality videoconferencing. Each time a patient needs a teleconsultation, a nurse or doctor in the remote site sends the history to the EMR server. EMR server forwards the request to the Alexandra Hospital for consultation. Geriatrics specialists at Alexandra Hospital carry out teleward rounds twice weekly and on demand basis. Summary of results: Following the implementation of the system, a trial run has been done. This shows a high degree of coordination and cooperation between remote site and the Alexandra Hospital Also the patient compliance is very high and they prefer teleconsultation. Conclusion: Initial results show that telegeriatric system has definite advantages in managing geriatric patients at a remote site. As the system evolves, further research will show the areas where telegeriatrics can be used optimally.

Multidimensional telecare strategies for rural residents with brain injury.

Rural residents with brain injury have difficulty in accessing care from qualified psychologists for consequent cognitive, emotional and behavioural symptoms. We examined high-quality videoconferencing to enhance care for persons with brain injury in three areas: cognitive assessment, psychotherapy and rural mental health training. The assessment study evaluated 52 outpatients seen for diagnostic visits over videoconferencing, and compared their experiences with those of 52 age- and diagnosis-matched controls seen in person. Persons seen via telemedicine were more likely than controls to want to repeat their experience and more satisfied than were the neuropsychologists who examined them. In the psychotherapy study, neurorehabilitation patients were seen via videoconferencing for therapy related to brain injury or stroke. Persons receiving psychotherapy were less likely than persons receiving assessment services to want to repeat their experience. In the training study, 39 rural mental health providers were trained via videoconferencing, and trainees demonstrated significant improvement on tests of knowledge about brain injury. Trainees formed a network of mental health provider referrals for persons with brain injury in a wide geographic area. Given adequate training and ongoing support, rural clinicians can treat many brain-injury adjustment issues locally, reserving specialist consultation for emergency or complex problems.

The RETAIN project: dicom teleradiology over an ATM-based network

The RETAIN project (Radiological Examinations Transfer on an ATM Integrated Network) has aimed at testing videoconferencing and DICOM image transfers to get advice about difficult radiological cases over an asynchronous transfer mode (ATM)-based network, which affords a more comfortable interface than narrow-band networks and allows exchange of complete image series using the DICOM format of studies. For this purpose, an experimental ATM network was applied between six university hospitals in four different countries. An assessment of the functionalities of the system was performed by means of log-file analysis, video recording of the sessions and forms filled out by the participants at the end of each session. Questionnaires were answered by the users at the end of the project to bring out perspectives of utilisation and added value. We discussed 43 cases during 20 sessions. For technical or organisational problems, only 20 of the 36 planned sessions took place. The throughput over ATM (10.5 Mbit/s, 20 times faster than six ISDN B-channels) was adequate. Despite the experimental configuration of the network, the system was considered as satisfactory by all the physicians. In 72 % of the sessions, the expected result (answer to the question) was gained. By common consent, videoconferencing was unanimously regarded as a prominent tool in improving the interaction quality. Asynchronous transfer mode is an efficient method for fast transferring of radiologic examinations in DICOM format and for discussing them through high-quality videoconferencing.

Videoconferencing for Speech and Language Therapy in Schools

TeachSpeech [1] is an innovative project that is investigating the use of high-quality videoconferencing technologies to deliver remote speech and language therapy support services to school children with communication difficulties. This paper reports the progress of the project, from initial concept through to the trial and preliminary results. The telepresence trial encompasses both tele-health and tele-education issues. The videoconferencing application has the potential to reduce costs while simultaneously improving access to speech and language therapy services.

LEVERAGE: Reciprocal peer tutoring over broadband networks

This paper reports on the experimental use of a broadband computer network hypermedia environment for language learning (French, English and Spanish). Using Web-based resources, students engage in a collaborative task over a network which offers high quality video-conferencing, application sharing and access to authentic multimedia resources. One of the main aims was to establish the practicalities of providing learners of languages with opportunities to engage in reciprocal peer tutoring. After outlining the pedagogical assumptions, and describing the set-up of the network-based learning environment, the trials are analysed, and the effectiveness of network-based language learning in supporting collaborative learning is discussed.

The past, present, and future of inverse multiplexing

Inverse multiplexing refers to the process of aggregating channels to allow applications greater freedom in selecting the optimum communication bandwidth and cost. The history of the Bandwidth On Demand Interoperability Group (BONDING) standard and its relationship to current and emerging network architectures are discussed. Applications of bandwidth-on-demand products to videoconferencing, multimedia, and LAN interconnection are described with respect to current and future equipment capabilities. Many data transmission applications require transmission at bit rates higher than those available from carriers. Services are most cost effectively provided if they have characteristics common among many user applications. The present paper describes an increasingly popular solution to this problem given today's expanding switched digital networks. Referred to as "inverse multiplexers" current implementations are providing national and international connectivity for diverse applications involving high-quality videoconferencing, variable-demand LAN interconnections, and low-cost network backup.< <ETX xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">&gt;</ETX>